Microangiopathic Haemolytic Anaemia in a Young Male Patient With Oesophageal Carcinoma.

Microangiopathic haemolytic anaemia (MAHA) in patients with various solid cancers and haematological malignancies has been reported, but to our knowledge, there has been no clearly reported case of MAHA in a young patient with oesophageal adenocarcinoma. MAHA is a subgroup of haemolytic anaemias characterised by destruction of red blood cells as they traverse small-calibre blood vessels. Its most defining features are anaemia and presence of fragmented red blood cells in the circulation. MAHA associated with cancer is now a well-recognized paraneoplastic syndrome, seen in various solid tumours and haematological malignancies, the most common being gastric, breast and lung carcinoma. The development of MAHA associated with any malignant process is usually an ominous condition, not only because of the fact that no convincing treatment has been discovered to date, but also because it invariably almost always occurs in disseminated cancers as a late presentation. The prompt identification of the signs and symptoms suggestive of intravascular haemolysis, the deliberation of the cause of such symptoms and the concurrent ruling out of related conditions which may mimic MAHA symptoms such as haemolytic uremic syndrome and thrombotic thrombocytopenic purpura are crucial to ensure successful treatment. The patient is a 33-year-old male patient of Asian descent who had oesophageal adenocarcinoma that had metastasized to the peritoneal cavity and para-aortic lymph nodes. The patient was admitted with bilateral extensive deep vein thrombosis, and was later found to have pulmonary embolism as well. A few days after his admission, he suddenly developed shortness of breath, severe chest pain and was diagnosed with cancer-associated MAHA. His sudden, rapid clinical deterioration, and the inability to intervene successfully was a traumatizing experience for his doctors and relatives alike.

MGN-3 arabinoxylan rice bran modulates innate immunity in multiple myeloma patients.

Dendritic cells (DCs) and natural killer (NK) cells are central components of innate immunity for controlling tumor growth. The therapeutic effects of certain anti-myeloma drugs are partially mediated by targeting the innate immune response. In addition, novel types of natural compounds have been developed that efficiently modulate the activity of both the cellular and humoral compartments of immunity. MGN-3 is known as an activator of natural killer cells, inducer of apoptosis and cytokine production, and modulator of dendritic cell maturation and differentiation in vitro. We have performed a randomized, placebo-controlled study to examine the effects of MGN-3 on innate immune system parameters in 48 multiple myeloma patients. We performed immunophenotypic analysis of peripheral blood samples, determined NK cell activity, and assessed the cytokine profiles of plasma before and during 3 months of treatment. The results demonstrate a clear increase in NK activity in MGN-3-treated patients compared to the placebo group, an increased level of myeloid DCs in peripheral blood, and augmented concentrations of T helper cell type 1-related cytokines. The present study suggests that MGN-3 may represent an immunologically relevant product for activating innate immunity in multiple myeloma patients and warrants further testing to demonstrate clinical efficacy.